CPT code 27097 is a medical billing code used for the revision of hip tendon procedures in healthcare settings.
CPT code 27097 is the procedure for the revision of a hip tendon. This code is used when a healthcare provider performs a surgical intervention to correct or improve the function of a previously repaired or damaged tendon in the hip area. The revision may involve reattaching, reconstructing, or modifying the tendon to enhance mobility or alleviate pain.
When billing for the CPT code 27097 (Revision of hip tendon), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both hips.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when the revision is part of a staged procedure or a related procedure performed during the postoperative period.
4. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is repeated on the same day by the same provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Indicates an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right hip.
9. Modifier LT - Left Side
Indicates that the procedure was performed on the left hip.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
Used when a non-physician provider assists in the surgical procedure.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27097 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. However, the final determination of reimbursement for CPT code 27097 may also depend on the guidelines and policies set forth by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and ensuring compliance with Medicare regulations, which can sometimes vary by locality. Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement details for CPT code 27097.
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